Computerisation of a paper-based intravenous insulin protocol reduces errors in a prospective crossover simulated tight glycaemic control study

SummaryBackgroundPaper-based continuous intravenous insulin protocols for tight glycaemic control (TGC) are typically complex, error-prone, time-consuming and burdensome. Little is known about the errors that occur as a result of misinterpretation and whether computerised protocols reduce errors.ObjectiveTo compare the errors resulting from protocol misinterpretation, time required to manage insulin infusions and nursing satisfaction between a computerised insulin protocol and a paper-based protocol.MethodsIn a crossover study, 62 ICU nurses completed 10 TGC simulated scenarios for the computerised and paper protocols. Scenarios evaluated three phases of insulin management: initiation, titration and transition. Scenarios response errors, time to completion and user satisfaction were examined.ResultsA total of 620 responses were recorded using both protocols. The computerised protocols were associated with higher user satisfaction, as well as: fewer errors in the titration (13 vs. 113 errors, p = .0001) and transition phases (9 vs. 23 errors, p = .001), fewer dosing errors, although not statistically significant (p = .096), in the initiation phase, and less time to complete in the titration phase (6 vs. 9.5 min, p = .0001).ConclusionsIn a simulated environment, a computerised protocol for TGC resulted in significant insulin dosing error reduction, saved time and improved nurse satisfaction.